Healthcare Provider Details

I. General information

NPI: 1730157272
Provider Name (Legal Business Name): BALDWIN WALLACE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BEECH ST
BEREA OH
44017-2088
US

IV. Provider business mailing address

275 EASTLAND RD
BEREA OH
44017-2088
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-2178
  • Fax: 440-826-3382
Mailing address:
  • Phone: 440-826-2178
  • Fax: 440-826-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS J LEE
Title or Position: VICE PRESIDENT FINANCE AND ADMIN.
Credential:
Phone: 440-826-8101